P0008 (S0014). - Palliative Percutaneous Biliary Radiofrequency Ablation With Stenting Compared to Biliary Stenting Alone in the Treatment of Unresectable Cholangiocarcinoma: A Meta-Analysis on Survival Outcomes
Jeffrey Rebhun, MD, Edward C. Villa, MD; University of Illinois at Chicago, Chicago, IL
Introduction: Patients diagnosed with unresectable cholangiocarcinoma (CCA) have a median survival of 3-6 months and often present with significant disease-related morbidity. Malignant biliary obstruction (MBO) is a common manifestation of CCA in which the biliary duct becomes blocked or obstructed by malignant overgrowth resulting in jaundice, pruritus, or possible infectious complications. Current palliative treatment with plastic or metal stenting offers little survival benefit to patients with unresectable disease. Percutaneous radiofrequency ablation (PRFA) is a novel palliative treatment option that, when used in conjunction with stenting, may offer significant life-prolonging results. The aim of this meta-analysis is to evaluate pooled survival data across studies comparing PRFA and stenting with conventional stenting alone. Methods: A comprehensive literature search was made using the PubMed database for manuscripts comparing survival outcomes for patients who underwent PRFA and stenting with those who underwent stenting alone. Studies evaluating recurrent CCA, post-surgical patients, or non-CCA malignancies without contingency data to extrapolate CCA-specific related data were excluded from analysis. Data across studies was pooled to generate a Kaplan Meier curve and log rank test was performed to compare differences in survival. Results: Two studies met inclusion criteria and were used for quantitative analysis. There was a total of 60 patients who were treated with palliative PRFA with stenting compared to 50 patients treated with biliary stenting alone. Mean survival of the PRFA with stenting group (7.7 + 3.6 months) and the biliary stent control group (5.9 + 2.5 months) differed significantly (mean difference of 1.8 + 0.6 months, 95% CI 0.6-3.0, p = 0.004). However, median survival did not significantly differ between the patients undergoing PRFA with stenting (7.2 months) compared to those undergoing biliary stenting alone (5.2 months; log-rank test z = 1.2, p = 0.2) Discussion: PRFA with concomitant biliary stenting may be a reasonable palliative therapy for those with previously untreated unresectable cholangiocarcinoma with evidence of increased mean survival. Given the lack of available studies on this patient population, more data is needed to draw conclusions of survival benefit relative to biliary stenting alone.
Figure 1: Forest Plot of Mean survival of patients with untreated, unresectable cholangiocarcinoma undergoing PRFA with biliary stenting compared to biliary stenting alone.
Figure 2: Kaplan-Meier survival curve of patients with untreated, unresectable cholangiocarcinoma undergoing PRFA with biliary stenting compared to biliary stenting alone.
Disclosures: Jeffrey Rebhun indicated no relevant financial relationships. Edward Villa: Olympus Corporation – Consultant.